痰TB-DNA、分枝杆菌核酸、涂片找抗酸杆菌及血T-SPOT.TB试验对肺结核的诊断价值研究

Sputum TB-DNA,mycobacterial nucleic acid,smear for acid-fast staining and blood T-SPOT.TB test study on the diagnostic value of the test for tuberculosis

目的通过研究统计痰TB-DNA、痰分枝杆菌核酸、痰涂片找抗酸杆菌、血清T-SPOT.TB试验对肺结核的诊断敏感度、特异度、诊断预测值、诊断准确率,进一步探讨不同临床检测方法对肺结核的诊断价值,指导肺结核患者的临床诊治。方法通过回顾性分析我院2017年1月-2019年12月呼吸内科、感染性疾病科诊断为活动性肺结核的患者,以痰结核菌培养结果为对照标准,分别统计出痰TB-DNA、痰分枝杆菌核酸、痰涂片找抗酸杆菌、血T-SPOT.TB试验对肺结核的诊断敏感度、特异度、阳性预测值、阴性预测值、诊断准确率,探讨我院临床上四种实验室方法对诊断肺结核的临床价值。结果通过上述方法统计出痰TB-DNA、痰分枝杆菌核酸、痰涂片找抗酸杆菌、血T-SPOT.TB试验对肺结核的诊断敏感度分别是84.7%、88.1%、74.7%、96.0%,特异度分别是65.3%、69.2%、86.5%、17.8%,阳性预测值分别是83.0%、85.%、92.0%、70.7%,阴性预测值分别是68.1%、73.5%、62.1%、68.4%,诊断准确率分别是78.2%、82.0%、78.5%、70.5%。结论跟传统方法痰结核菌培养、痰涂片找抗酸杆菌比较,TB-DNA、分枝杆菌核酸、TB-SPOT.TB试验在时效、灵敏度方面更具优势,能敏感检测出人体是否感染肺结核,对患者的早期诊断及指导治疗具有重要意义。

Objective To investigate the diagnostic sensitivity,specificity,predictive value and diagnostic accuracy of TB-DNA,mycobacterium sputum nucleic acid,acid-fast bacilli on sputum smear and serum T-SPOT.TB test for tuberculosis,so as to further explore the significance of different clinical detection methods for tuberculosis and guide the clinical diagnosis and treatment of tuberculosis patients.Methods By retrospective analysis of January 2017-December 2019,patients from respiratory medicine,infectious diseases departments diagnosed with active tuberculosis,sputum culture results of tuberculosis bacterium as control standard,we figured out sputum TB-DNA,sputum mycobacterium nucleic acid blood,sputum smear for acid fast bacilli,T-SPOT.TB test to the diagnosis sensitivity,specific degree,positive predictive value,negative predictive value,diagnostic accuracy,to explore the clinical value of four clinical laboratory methods in our hospital.Results According to the above methods,the diagnostic sensitivity of sputum TB-DNA,sputum mycobacterial nucleic acid,sputum acid-fast bacilli on smear and blood T-SPOT.TB test for tuberculosis was 84.7%、88.1%、74.7%、96.0%,and the specificity was 65.3%、69.2%、86.5%、17.8%,respectively.The positive predictive value was 83.0%、86.6%、92.0%、70.7%,and the negative predictive value was 68.1%、73.5%、62.1%、68.4%,respectively.The diagnostic accuracy was 78.2%、82.0%、78.5%、70.5%,respectively.Conclusion Compared with the traditional methods of culture and sputum smear for acid-fast bacilli,TB-DNA,mycobacterial nucleic acid and T-SPOT.TB test had more advantages in terms of timeliness and sensitivity.It is great significance for the early diagnosis and treatment of patients to detect whether they are infected with tuberculosis sensitively.